Final Consult with Surgeon

Veggestyle · October 19, 2006

Hello Everyone!

Tomorrow I am going in for my final consult with the surgeon. My sugery is scheduled for Nov. 20th! I have been working on being banded since July now and I am really excited, nervous..etc.

I was wondering if anyone had any words of wisdom or suggestions of what to ask/talk to with the surgeon during this imporant appt. before I am actually operated on!

Veggestyle · October 20, 2006

I was hoping that anyone out there could give me so advice...I hope that I havent offended anyone...

JulieNYC · October 20, 2006

Ok, Veggie, you asked for it! These were some of the questions I asked. I'm sure there are many others that are good too, but this is what I wanted to know at the time (though, of course, now I'm far more informed).

Medical Device Questions<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /><o:p></o:p>

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1. I know there are three sizes of bands (9.75, 10, VG), but there is conflicting information on how much saline each size holds. I assume this is because though Inamed lists a max fill for each size, some docs technically overfill if necessary. Can you clarify? I want to know exactly what is in my body, post-surgery.<o:p></o:p>

2. There is a lot of speculation on the internet that the VG band is safer in the long run in avoiding slippage because its pillow design puts less pressure on the organ. Do you lean toward the VG if appropriate, or is your choice completely based on the size of the organ?

3. I read that Inamed is coming out with two new bands, the biggest difference being that they are unlockable. What benefit is that? I see no reason to wait on them, do you agree? <o:p></o:p>

4. I read a statistic from early trials that 2% of bodies reject the band as a foreign objection. What, if any, rejection rate have you seen clinically?<o:p></o:p>

5. When at a more reasonable weight, I am quite petite. Can you install a low profile port from the outset? If not, what is involved, surgically, in changing the port once I’m at a lower weight? General anesthesia?<o:p></o:p>

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Fill Questions<o:p></o:p>

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1. You have a reputation as a patient-driven, aggressive fill doctor, which is one of the reasons I chose you. How long after surgery to my first fill? How long to the second fill if the first fill doesn’t give enough restriction, as I understand is very often the case? Would you ever not tell a patient how much fill they have, if they wanted to know? <o:p></o:p>

2. Often I hear that to find the “sweet spot” can be an adjustment of only .1 or .2 cc’s of saline, particularly if you’re over-filled. Is it tiring for you or your staff if someone asks for such a small adjustment, or do you consider than part of the banding process?<o:p></o:p>

3. In your opinion, do frequent fills lead to esophageal spasms? <o:p></o:p>

4. For someone like me who needs to lose quite a bit of weight, is the goal to get right to the “sweet spot” or do you try to save room in the band to be able to safely tighten it when you hit a major plateau?<o:p></o:p>

5. Under what circumstances do you use flouro instead of doing a blind fill?<o:p></o:p>

6. I know you do some fill appointments yourself, but if for scheduling purposes I wind up seeing your nurse practitioners more often than you, if everything is going ok would you still want to see me yourself from time to time? If so, how often?<o:p></o:p>

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Aftercare Questions<o:p></o:p>

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1. I understand that some doctors don’t recommend taking naproxen sodium or Advil ever, post-band. I use these, particularly during my cycle. If they don’t irritate my stomach, can I still take them? If not, what do you recommend as an anti-inflammatory and fever reducer? Also, are antibiotics necessary for more than routine dental work?<o:p></o:p>

2. Here’s something that came up on a message board that didn’t make sense to me. Some people were talking about wearing a medic alert Bracelet to let rescue workers know that they had a band in the event they are rescued and unconscious. Their logic was that intubation of a banded person isn’t the same. Is that really a concern? It doesn’t seem to be physiologically correct to me (airway and stomach being separate).<o:p></o:p>

3. I’m concerned generally about this surgery and the long-term health of my esophagus and gallbladder. Do you recommend medicine to reduce gallstones during the early weight loss phase, particularly if it is more rapid that a lower BMI patient would experience?<o:p></o:p>

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Surgery Questions<o:p></o:p>

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1. I know slippage was a bigger concern with earlier surgical technique. What surgical techniques do you use to prevent slippage? Pars Flaccida? Stitch in the diaphragm? What slip rate have you seen clinically from your patients?<o:p></o:p>

2. Where will the port be placed? Can you avoid the left side, so that I can play violin as soon as possible? Also, I sleep on my left side. Also, I will almost certainly have a Tummy Tuck, given that my Dad’s a plastic surgeon. I’ve read at least one example of a port getting dislodged in reconstructive surgery if it’s placed low. Is that a fluke, or not a concern with an excellent plastic surgeon?<o:p></o:p>

3. Many people have told me that the worst part of surgery is the left shoulder pain from the CO2. Is there anything you or I can do to reduce that? Do you prescribe Levsin?<o:p></o:p>

4. I will follow a pre-surgery diet with rigidity for as long as you recommend. With that as a given, but also understanding that I am a higher BMI patient, what do you think is the percentage chance that you would have to convert my surgery to an open procedure?<o:p></o:p>

5. What kind of closure do you do on the incisions? Stitches? Glue? What do you do to make them pretty?<o:p></o:p>

6. ** I very much want to go home that day, assuming no complications, the day of surgery. I understand that’s more likely if I have the first surgery of the day. Will you take that into consideration when scheduling me, with the understanding that it may push my surgery date out a little?<o:p></o:p>

7. ****I chose you as a surgeon for many reasons, but the driving factor was that you’ve done four thousand procedures and if someone is going to be poking around with sharp metal instruments near my liver and spleen, I only wish to trust someone who has done four thousand procedures. I understand NYU is a teaching hospital and that your practice is training a surgical fellow. Is there any chance anyone but you will be handling any portion of the actual surgery?<o:p></o:p>

8. Are there any particular concerns you have specific to me, as opposed to other patients? Is there anything I can do to make the surgery itself easier for us both? Is there anything I can do to be a superstar success story that you think I might not already know from my research?<o:p></o:p>